Androgen deprivation therapy for the treatment of prostate cancer: consider both benefits and risks.
BACKGROUND
Androgen deprivation therapy (ADT) is increasingly used for the treatment of prostate cancer (PCa), even in clinical settings in which there is no evidence-based proof of prolonged overall survival (OS). ADT, however, may be associated with numerous side effects, including an increased therapy-related cardiovascular mortality.


OBJECTIVE
To discuss different clinical settings in which ADT is currently used and to critically weigh the benefits of ADT against its possible side effects.


METHODS
A MEDLINE search was conducted to identify original articles and review articles addressing the efficacy and side effects of ADT for the treatment of PCa. Keywords consisted of prostate cancer, hormonal therapy, adverse effects, radical prostatectomy, and radiotherapy. The articles with the highest level of evidence for the various examined end points were identified with the consensus of all authors and were reviewed.


RESULTS
Even short-term use of ADT may lead to numerous side effects, such as osteoporosis, obesity, sarcopenia, lipid alterations, insulin resistance, and increased risk for diabetes and cardiovascular morbidity. Despite these side effects, ADT is commonly used in various clinical settings in which a clear effect on improved OS has not been shown.


CONCLUSIONS
ADT is associated with an increased risk of multiple side effects that may reduce quality of life and/or OS. Consequently, these issues should be discussed in detail with patients and their families before initiation of ADT. ADT should be used with knowledge of its potential long-term side effects and with possible lifestyle interventions, especially in settings with the highest risk-benefit ratio, to alleviate comorbidities.
Isbarn
Hendrik
H
Martini-Clinic, Prostate Cancer Center Hamburg-Eppendorf, Hamburg, Germany. hendrikisbarn@gmail.com
Boccon-Gibod
Laurent
L
Carroll
Peter R
PR
Montorsi
Francesco
F
Schulman
Claude
C
Smith
Matthew R
MR
Sternberg
Cora N
CN
Studer
Urs E
UE
D000726:Androgen Antagonists / Q000009:adverse effects / Q000627:therapeutic use; D003131:Combined Modality Therapy; D007987:Gonadotropin-Releasing Hormone / Q000819:agonists; D006801:Humans; D008297:Male; D009919:Orchiectomy / Q000009:adverse effects; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000628:therapy*; D018570:Risk Assessment
D000726:Androgen Antagonists; D007987:Gonadotropin-Releasing Hormone